Diagnosis and treatment planning and infection control - PowerPoint Presentation

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Diagnosis and treatment planning and infection control

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Examination

The procedure for examination of the patient requiring R.P.D consists of a thorough and systematic investigation of the structure of stomatognathic system and the symptoms presented by the patient. A systematic examination is usually started with:

The patient needs or complain

Clinical examination

Radiographic examination

Diagnostic cast "study cast"

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Clinical examination

1. Extraoral examination

Face

Position of the lips

Mouth opening

Deformity , symmetry , eye and sclera

Short or long lip

Deformity , symmetry , eye and sclera

2. Intraoral examination

Visual examination

Digital examination

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Intraoral examination

Visual examination

visually we can estimate the following:

1. Caries susceptibility

2. Position of the remaining teeth and their condition

3. Condition of soft tissue

4.

The occlusion of the teeth

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Intraoral examination

Visual examination

1. Caries susceptibility

number of remaining teeth

the presence of carious teeth

number of restored teeth

evidence of decalcification

the oral hygiene of the patient

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Intraoral examination

Visual examination

2

.

Position of the remaining teeth and their condition

Inclined

Tilted

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Intraoral examination

Visual examination

3. Condition of soft tissue

change in color of mucosa

presence of inflammation

swelling and ulcers

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Intraoral examination

Visual examination

4.

The occlusion of the teeth

retention between maxillary and mandibular arches

extreme overlapping

extrusion of teeth

Inter-arch distances

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Intraoral examination

Digital examination

1.

The firmness of the remaining teeth or mobility of teeth

as mobile teeth are expected to be weak teeth and can not with stand the forces of the P.D

cause of mobility either an occlusive trauma which will give ______ prognosis or inflammation of periodontal tissue which gives _________ prognosis

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Intraoral examination

Digital examination

2.

Condition of periodontal tissue and presence of pocket and the depth of this pocket.

usually measured by periodontal probe which shows the amount attachment of periodontal ligament on the surface of teeth

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Intraoral examination

Digital examination

3.

The extent of caries

caries can be detected by exploration of the occlusal surface of teeth using the dental probe also the teeth can be examined by tapping method. Also the sensitivity of teeth should be checked either electrically or chemically using (ethyl chloride).

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Intraoral examination

Digital examination

4.

Condition of restored teeth

5.

Condition of the soft tissue

6. Examination of the saddle area for number, location and quality of the residual ridge

7. The evaluation of the depth of lingual sulcus and the floor of the mouth.

broken filling (defected filling) or the presence of recurrent caries.

through palpation for any pain or swelling

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Does The stone cast usually gives

true

determination of the depth of the lingual sulcus?

Answer : no it will give a false determination

Displacement of the tissue during taking impression

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3. Radiographic examination:

A.

the quality of the alveolar bone and the presence of retained roots, impacted teeth, cysts, tumors also the amount of bony support for the teeth therefore.

the tooth which is clinically sound, may appear in the radiograph

without bony support which give

poor prognosis to use it as abutment Short rooted teeth will give us poor prognosis to use as abutment for R.P.D.

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3. Radiographic examination:

B .

the root morphology:

Multiple divergent roots.

Conical rooted teeth.the crown/root ratio.

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3. Radiographic examination:

C .

Bone loss

and

discontinuity of lamina dura which indicate and give us an idea about prognosis of the case and the periodontal inflammation.

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3. Radiographic examination:

C .

Caries extent especially proximal caries can be seen by x-rays.

the x-rays which should be taken for a complete examinations:

Orthopantomography.

Full-mouth periapical.Bitewings "for proximal caries". Occlusal x-rays.

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Diagnostic cast "study cast"

Diagnostic cast should be

surveyed

for the following purpose:

To see the path of insertion and removal of the R.P.D.

occlusal rest preparation.reshaping of the abutment which include:Embrasure clearance. Excessive contour requiring reduction.

Creation of undercut by disking and dimples or grooves, but all these preparation should be done within the enamel, if requires exposure of dentine then the tooth should be rounded,Acute angle should be rounded.

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Diagnostic cast "study cast"

Diagnostic cast should be

surveyed

for the following purpose:

4. see the retentive and non retentive area of abutments.

5. preliminary designing of R.P.D.

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the study cast should be mounted in the articulator for the following:

Assessment of occlusion

for degree of over closure, the amount of

interarch

distance , for proper setting of the artificial teeth especially in region of tuberosity and retromolar area. Extrusion of the teeth into the opposing edentulous area

, also migration or rotation of the teeth into the adjacent edentulous area.Viewing the occlusionfrom the lingual side as well as from the

buccal side for proper placement of the occlusal rest, clasp arms, and minor connector. The diagnostic cast can be used as a reference during treatment of the patient.Fabrication of the special trays.

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Treatment plan:

Periodontal treatment and splinting of weak mobile teeth.

Oral hygiene habits

restoration of teeth

the need for surgery which includes:

Removal of hyperplastic tissue.

Removal of tori.Extraction of teeth.

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The extraction of teeth indicated in case of:

unrestorative teeth

When the presence of healthy tooth complicate the design of R.P.D "extremely inclined teeth

mesially

, lingually, and buccally".unesthetically located teeth, therefore they are removed to improve appearance.Orthodontic treatment.

Treatment plan:

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fixed partial denture "crown and bridge" if we have Cl 1 with anterior modification it is easier for us to make fixed appliance anteriorly so we will get pure Cl 1 so handling with it more easier than that with modification.

Type of material used in removable partial denture.

Cost of the partial denture.

Treatment plan:

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Prognosis

The prognosis is usually derived from the resistance of the tissue to the causative factor; therefore, the more resistance is the tissues to local factor. The more favorable is the prognosis.

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There are certain factors we should consider in prognosis:

Age of the patient

: when bone loss is comparable between young and older patients then the prognosis is more favorable for the older patient.

The number of remaining teeth

: insufficient number of teeth provides poor foundation of the removable partial denture.

The height of bone of the remaining teeth : the higher the level of the bone. The better is the prognosis.The shape and the length of the root and usually short and conical roots will give less favorable prognosis than multiple divergent root.

Mobility of teeth.

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Infection control in prosthodontic

Human mouth is first exposed to microorganisms during birth. Oral cavity supports one of the most concentrated microbial populations of the body.

Prosthodontics treatment also demands a high degree of concern about cross infection through patients, personnel, unsterilized instruments and equipment’s. Prosthodontics treatment undertaken in the clinics should be supplemented by the laboratory and hence cross infection chances have to be halted in both the fronts.

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Infection control in prosthodontic

A number of disinfection and sterilization procedure are available that claim to kill the microorganism. Efficiency of the method is not very often posted but the reactivity of the materials used in Prosthodontics possess problems of feasibility and decrease to accuracy. A careful selection of methods of sterilization and disinfections is essential in Prosthodontics and this work is an attempt to find out an optimum disinfection procedure.

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Clinical and Laboratory Disinfection

Barrier system

Gloves

Utility gloves

Mask, protective eyewear, clothing

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Disinfection of Impressions

American Dental Association (ADA) guidelines state that impressions should be rinsed to remove saliva, blood and debris and then disinfected before being sent to the laboratory.

When considering methods of disinfection for impressions, two factors are important:

1) the effect of the treatment on the dimensional stability and surface detail of the impression.

2) the deactivating effect of the impression material on the disinfecting solution, which could reduce the efficacy of the process.

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Disinfection of Impressions

Immersion disinfection has been preferred to spraying. Immersion is more likely to assure exposure of all surfaces of the impression to the disinfectant for the recommended time.

Spraying disinfectants onto the surface of the impression reduces the chance of distortion, especially in the case of alginate,

hydrocolloid and polyether materials, but may not adequately cover areas of undercuts. Thorough rinsing of the impression is necessary before and after disinfection.

Rinsing before removes the bioburden present, which may prevent exposure of the surface to the disinfectant. Rinsing after disinfection removes any residual disinfectant, which may affect the stone surface after the cast has been poured.

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ADA-recommended disinfectants

Chlorine compounds such as sodium hypochlorite solutions (1:10 dilution), iodophors, combination synthetic phenolics:

The impression should be handled carefully to prevent distortion. In order to remove any bioburden, the impression should be gently scrubbed with an artist's brush (one-half inch bristle) and a liquid detergent.

Stubborn materials can be removed by scrubbing gently with dental stone sprinkled into the impression.

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ADA-recommended disinfectants

Reversible (Agar) and irreversible hydrocolloid (Alginate) materials:

Spraying

(Iodophors, sodium hypochlorite (1:10), chlorine dioxide )

Polyether impression materialsSpraying (Sodium hypochlorite (1:10))Silicone (vinyl polysiloxane) or rubber-based impression: Immersed in( any hospital-level disinfectant except

neutral glutaraldehyde) Zinc oxide eugenol (ZOE) and compound impressions:Immersed ( 2% gluteraldehyde or a 1:213

iodophore solution for ten minutes)impression compound:Immersion ( sodium hypochlorite (diluted 1:10))

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ADA-recommended disinfectants

Impression trays:

Plastic

disposable

trays used are discarded.Sodium hypochlorite can be used as a disinfectant on aluminium

- or chrome-plated trays. But these trays should be monitored for corrosion. If corrosion occurs, an alternative disinfectant should be used.Impression trays can also be heated

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